Innovation and Technology

One of my favorite toys growing up was an Erector Set. For millennial readers out there, an Erector Set is a construction toy that contains a lot of flat metal struts with regularly spaced holes, and nuts and bolts to tie them together. They had motors, pulleys, and gears that allowed you to build a model, take it apart, and build something new – over and over again. I didn’t know then that in 1949, two physicians at Yale used an erector set to build a prototype of an artificial heart.

Fast forward to today. Our tools for individuals to build and tinker with have evolved on a large scale. We now have the technology, design tools, making tools, and entrepreneurial spirit to enable those that are closest to healthcare challenges to channel their spirit of invention, creativity, and natural-problem solving skills to create usable solutions that matter to them.

Enter the Maker Movement. A new making infrastructure is springing up around us. The MakerNurse project has given nurses the tools and space needed to translate ideas into prototypes and prototypes into solutions. The MakerHealth Space at the John Sealey Hospital at The University of Texas Medical Branch in Galveston is equipped with adhesives, fasteners, textiles, electronics (sensors and micro-controllers), and a range of tools (pliers, sewing needles, 3D printers, laser cutters, vacuum formers, sterilizer, and tabletop milling machines). There are workspaces specialized for specific medical challenges, such as fluid control or assistive technology.

The nurse manager in their Blocker Burn Unit developed a three-headed shower head using PVC pipes and 3-D printed components, eliminating the need to hold a shower head for hours at a time whenever chemical-burn patients entered the ER. Makers are encouraged to record “how-to’s” so that others can recreate and build on others’ solutions.

It is not just front-line workers who are solving problems. It is also patients, who best understand their pain points and are therefore uniquely positioned to make solutions. A 14-year-old cystic fibrosis patient designed a device to dry her nebulizer with some wooden sticks, plastic rings made with a 3D printer, and an electric fan.

With the Maker Movement penetrating health, the concept of “personalized medicine” can be interpreted in a new dimension: Personalized medicine includes medicine made by a person for a person. It is an individual using physical tools to cut, mold, and shape solutions to challenges that they understand intimately from personal experience.

On Thursday, June 23, individuals and organizations committed to creating better health through hardware, medical, and assistive devices exhibited at Making Health, an interactive showcase at the Leavey Center at Georgetown University.

The mission of the MedStar Institute for Innovation, the organization that I have the privilege of leading, is to catalyze innovation that advances health. I can think of no better way of doing that than to support and encourage the Inner Maker in all of us.

In May, MI2 participated in the Digigirlz Hackathon: a 2-day health hackathon for 50 middle school aged girls from DC public and charter schools. Here are 5 things the girls taught us about creating and providing digital health solutions:

The (dare I say, obvious) need for connectivity

Watching semi-kids use technology is a blatant reminder that technology is built into the DNA of our future patients. The girls effortlessly created solutions linking biosensors and mobile technology, envisioning complex algorithms that require significant machine learning and use of Google-esque data sets without even realizing the sophistication of what they were envisioning. One could chalk this up to naiveté and a lack of technical understanding, but I would posit that is too diminutive. What we witnessed, in fact, is a group of future leaders and patients who expect from us total, seamless connectivity. And we would be wise to work toward that vision in every health domain.

This May, MedStar Health, Microsoft, Cardinal Health, and 1776 organized a two-day health hackathon for 50 middle-school aged girls from DC public and charter schools as part of Microsoft’s Digigirlz programming, which tackles disparities in STEM education. Microsoft, Cardinal Health & MedStar trainers and mentors educated the girls on ideation techniques, app wire framing, and app design, and advised and assisted the girls in their solutioneering.

The event importantly recognized similarities between STEM education and wellness education: both are necessary to habituate at a young age, and both are drastically under-represented in the education of young Americans. For that reason, embedded into the day’s training were ways to address concrete health concerns that could directly benefit the girls’ wellbeing: managing stress and engaging in healthy habits.

The day served to address multiple truths facing the health industry: More

Everyone seems to be talking about “innovation” these days, but what exactly does innovation mean for you and your health care?

On May 13, I spent an inspirational day hearing from healthcare thought leaders and entrepreneurs from across the globe at the 1776 Challenge Festival Health Conference sponsored by MedStar Health; a week later I spent two vibrant days organized by BluePrint Healthcare Innovation Exchange with representatives from 26 health innovation centers from across the country and England — and my head is spinning with ideas and opportunities for innovating in the healthcare arena.

Health care is dramatically changing. As Mark Smith, Chief Innovation Officer at MedStar and Director of the MedStar Institute for Innovation noted in his recent blog, there are three key trends to note:#1 The patient will be in charge.#2 Clinical incentives will align with financial incentives. #3 Health systems will provide ongoing caring for health (not episodic treatment of illness) in multiple settings and platforms — and very diverse data sources will provide deep insight into individual diagnoses and treatment.

A kiosk that streamlines patients with uncomplicated Urinary Tract Infections (UTIs) in an Emergency Department (ED); that seems like a no-brainer. Just develop an algorithm, install the kiosk, get nurses to direct patients to it, and let the magic happen.

Every healthcare entrepreneurs should ask themselves two questions after reading this article:

#1 Am I assuming that all patient populations are the same? The kiosks Ackerman studied were somewhat successfully deployed in an urgent care setting prior to deployment in the ED. Most people would think that More

Given how ubiquitous fitness trackers have become (even before fitness watches appear in droves in 2015 and beyond), think hydration tracking next.

About 3.3 million fitness bands and activity trackers were sold between April 2013 and March 2014 in the U.S. through bricks-and-mortar retailers or large-scale e-commerce sites, according to the NPD Group.

But no one ends up in the Emergency Room for being too sedentary…

Consider the Annals of Epidemiology, Volume 17, Issue 9 , Page 736, September 2007, and this article by S. Kim More

The iBeacon from Apple is intriguing — how might it be used in healthcare?

SOURCE: Apple

According to Apple in December 2013, when it was announced:

iBeacon is a new technology that extends Location Services in iOS. Your iOS device can alert apps when you approach or leave a location with an iBeacon. In addition to monitoring location, an app can estimate your proximity to an iBeacon (for example, a display or checkout counter in a retail store). Instead of using latitude and longitude to define the location, iBeacon uses a Bluetooth low energy signal, which iOS devices detect. To learn more about Bluetooth technology, see the official Bluetooth website.

To use iBeacon, you need iOS 7 or later, Bluetooth turned on, and a compatible iOS device:

iPhone 4s or later

iPad (3rd generation) or later

iPad mini or later

iPod touch (5th generation) or later

You can control which apps and system services access Location Services data, including iBeacon: Tap Settings > Privacy > Location Services.

Healthcare has many vast bricks-and-mortar facilities where we might aim to keep track of providers & patients– not in an inappropriate way, we’d posit– just to ensure the right folks are connected at the right time in the right place. Think of it this way:

“We need Dr. Jones in Room #14– where is he now?”

Or “We’re ready to see the patient with initials P.R. — where is she now in the building?”

While much of the buzz about iBeacon has related to retail, whereby one could (as an example) get an electronic coupon on the fly, I think there are myriad potential compelling uses in… the medical arena.

Think about it– traditional medicine is about a human encounter typically at the time your symptoms pop outside the norm, or AFTER this happens. Often, you hear the platitude “if we had only caught this earlier….”

That’s why today is the very best time to be a doctor. In the pre-mHealth era, doctors spent voluminous time COLLECTING the dots (data) … so they could then CONNECT the dots (figure out what’s wrong with you), so the right therapy can ensue. I imagine this might have been 80/20– with the 80 being dot-collection.

Leaving far too little time in the average seven-minute appointment for the discovery.

Now, as the Tom Cruise character represented in Minority Report in the scene depicted above, there will be plenty of More

What happens when you teach first year medical student to code and be entrepreneurs?

Answer: Great prototypes of original ideas on volunteering in hospitals, choosing a doctor for a virtual visit, and visualizing the business health of a medical practice.

At the advice of a long time friend, I decided to teach an eight class selective at Georgetown University School of Medicine called “Hacking Healthcare.” I would teach medical student front end web coding. Besides specializing in Emergency Medicine, I consider learning to code HTML/CSS/Javascript to be one of the turning points in my career. Coding let me stop being strictly an “idea guy,” and rather become an agent of implementation. I wanted to share this ability to make ideas happen with a new generation of medical students. Most medical professionals are great at analysis and criticism, however, few are able to create. I wanted to teach them to create.

Mike Bright:
Another instance of microvolunteering in hospitals is this call-out for research on how microvolunteering actions might benefit a patient. http://helpfromhome.org/do-more/volunteer-for-us/promoting-microvolunteering-to-hospitals

We ran across the NINDS data in an appendix to A Graphic Reanalysis of the NINDS Trial (Ann Emerg Med 2009; 54(3):329-36) and thought it was a gold mine of interesting data.

Hoping to better see the natural history of stroke, we came up with one nice visualization of the data. Since it is animated, we cannot submit it. But if you would like the check it out, you can on YouTube. It uses patients who had no neurological deficit before their stroke (approx 550) and follows their NIH Stroke Scale (NIHSS) at a few different data points. You can see each patient get worse or better throughout the study (at one day after stroke, 7-10 days after stroke, and 90 days after stroke). The y axis is the baseline NIHSS severity of stroke, while the x axis is the NIHSS severity of stroke over time. At twenty four hours, the severity of stroke appears to be all over the board, however, at 90 days, patients tend to get better (move to the left) or succumb (move to the right with an NIHSS of 42). More

Chances are … yes. If you use browsers (which you obviously do if you are reading this), chances are you are using “javascript.” Javascript goes hand in hand with the modern web. You are using it right now. And javascript is full of callbacks.

These are not HCAHPS callbacks for patient satisfaction. Those are important, but for other reasons.

Rather, these callbacks in programming languages like javascript are things that happen when something else happens. As a real world example of a callback, imagine a doctor in… More

The mHealthSummit gets bigger by the year (5,000 attendees from 60 countries this time around), and here are three takeaways from the event just ended, at the National Harbor in Washington, D.C. from December 9-11, 2013:

ENORMOUS: Increasingly the vendors are BIG. In mHealthSummits past, the exhibitors typically had highly innovative products, but were not firms you’d recognize. Now, the names are like this: Sprint, AT&T, Verizon, Qualcomm, Intel. Of course, many small companies also participated, and many of these are very well funded given the tsunami of venture capital funds that have hit the beach.

Medical futurist, software architect, and health IT strategist, Dr. Michael Gillam launches his first of many Dispatches from… Somewhere in the Future – Serving as faculty at Singularity University’s FutureMed Program, Dr. Gillam extracts the best of his notes from prior sessions. As a prelude to future posts, he kicks off with 8 Must-Haves for creating innovation in your organization. More

The patients are sicker. There’s fewer staff. Technology is outpacing your facility’s ability to adopt it. Data management systems are being revamped. The Emergency Department is over-capacity. And in the midst of all of this, you must be prepared for larger scale emergency. Such is the plight of ED Directors everywhere.

So, you want a re-design. You want an overhaul. Well, guess what? You’ve got one shot… a one-time opportunity to employ evidence-based physical design strategies. The Center For Health Design and MI2 hear you. More

Action is a necessary ingredient for innovation. And health innovations are notoriously difficult to fund – often relying heavily on the time-consuming process of obtaining grants or yielding some ownership through venture capital. Well, new opportunities are presenting themselves. Health innovations may be funded through crowdsourcing sites like Kickstarter and through progressive employers like MedStar Health.More

It took consuming citrus fruits for the prevention of scurvy 264 years from discovery to widespread adoption. Today, the time from discovery to implementation is estimated at 17 or 18 years. How much can we close this gap? In this video from FutureMed, medical futurist Dr. Michael Gillam explores this answer and where he expects us to be in 2025.

Watch for Dr. Gillam’s Dispatches From…Somewhere In The Future coming exclusively to MI2.org soon. More